Comparing long-term outcomes between drug-eluting and bare-metal stents in the treatment of cardiac allograft vasculopathy.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is the leading cause of death after the first year following heart transplantation. We compared restenosis rates, mortality, and other major adverse cardiac events (MACE) between transplant recipients treated with DES and BMS for CAV.
METHODS: All patients from our heart transplant registry undergoing PCI with stenting for CAV were identified. Procedural data, baseline clinical characteristics, yearly coronary angiography, cardiac events and death were prospectively collected. Primary outcome was in-stent restenosis (ISR). Secondary outcomes were in-segment restenosis, target vessel revascularization (TVR), all-cause mortality and combined MACE.
RESULTS: 36 lesions in 25 patients treated with DES were compared with 31 BMS-treated lesions in 19 patients. There were no significant differences in baseline characteristics. 12-month incidence of ISR was 0% with DES vs. 12.9% with BMS, P = 0.03. Over mean (+/-standard error) follow-up of 51.1 +/- 7.5 months this difference was significant for vessels < or =3 mm in diameter, hazard ratio (HR) DES vs. BMS 0.37 (95% CI 0.11 to 0.95) P = 0.037; but not for vessels >3 mm P = 0.45. However, there was no difference in overall longterm patency because of similar rates of in-segment restenosis between DES and BMS, HR 1.13 (95% CI 0.43 to 2.97) P = 0.81. Also, the rates of TVR, death from any cause and combined MACE were similar; log rank P 0.88, 0.67, and 0.85, respectively.
CONCLUSION: This study suggests that after PCI for cardiac allograft vasculopathy, despite a lower in-stent restenosis rate in DES compared with BMS, in-segment restenosis and clinical cardiac endpoints are similar.